A multimillion pound machine that is set to revolutionise radiotherapy has hit the headlines today.
The MR Linac combines two technologies – an MRI scanner and a linear accelerator – to precisely locate tumours, tailor the shape of X-ray beams in real time, and accurately deliver doses of radiation even to moving tumours.
Its potential to transform patient care was hailed at a press briefing in central London, where experts from The Institute of Cancer Research and our hospital partners The Royal Marsden talked about the very latest research in radiotherapy.
The problem the MR Linac is trying to solve in treating cancers was described eloquently by Professor Uwe Oelfke, Head of the Joint Department of Physics at the ICR and The Royal Marsden: “We face the immense challenge of trying to hit an invisible target with an invisible beam.”
It may surprise many to know that the location of tumours and organs at risks within the body changes from day to day or even constantly. For example, a tumour in the lung will move up and down as a person breathes, and a tumour in the prostate might move from day to day depending on what the person has eaten and how full their bowel is.
High-tech scans with x-rays are currently taken before radiotherapy to locate the tumour, and sophisticated dose delivery systems then shape the radiotherapy beam to where the tumour is anticipated to be. But, for many clinical applications, the image quality of these scans is not sufficient to reliably distinguish the tumour from surrounding healthy tissues. Furthermore, there is still a risk that the tumour may have shifted slightly since the scan was taken, and that radiation may hit adjacent healthy issues.
Constant monitoring of the patient during treatment will enable the most precise targeting of the tumour and help avoid healthy tissue. This is key to refining radiotherapy for the future and is what the MR Linac promises.
Professor Oelke told the briefing, "The MR Linac will allow us to constantly image the tumour during radiotherapy and allow us to adapt the treatment in real time. This would be a truly new practice and we would be entering into a new era of personalised radiotherapy.”
The MR Linac is currently being built at the ICR’s and The Royal Marsden’s Sutton site in south London, using a £10 million grant from the Medical Research Council. The application for the grant was a joint effort between the ICR, The Royal Marsden, the UK research partnership and Elekta, developer of the pioneering radiotherapy system.
MR Linac is not the only exciting development in radiotherapy that was discussed at the briefing.
Professor Kevin Harrington, Joint Head of the Division of Radiotherapy and Imaging at the ICR, told of how radiotherapy may act as a boost to the immune system to help rid the body of cancer.
New immunotherapies are now being tested alongside radiotherapy with the expectation this will provide benefits for patients.
Dr Navita Somaiah explained how clinical trials run by the ICR and The Royal Marsden are giving a better understanding of how to personalise radiotherapy to breast cancer patients. And Dr Aisha Miah told how Cyberknife, another technology that uses imaging alongside radiotherapy delivery, is being used at The Royal Marsden, and how efforts are being made to reduce the long-term side-effects of radiotherapy for those who survive cancer. The speakers also told about their excitement that radiotherapy can be used alongside biologically targeted therapies and that this is another approach that may provide patient benefit.
That is all good for the future, but what about patients and how they are treated now?
Professor Harrington told journalists at the press briefing that it's a little-known fact that radiation plays an important role in the treatment of about 50% of patients who are cured of cancer. Despite this, radiotherapy still has a bad reputation, and patients often have a frightening vision of what they are going to undergo. He stated that the reality is very different as patients usually see state-of-the-art equipment and receive cutting-edge therapy.
So while we can expect radiotherapy will generate more headlines in future, we should be enthusing too about the role radiotherapy is playing in improving patients’ lives right now.
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